Re: Re: Evidence-based Care

[Guest guest]

Jean- your typing is almost flawless... is it really you?Tim: I was reviewing costs of health care recently.. it is difficult to analyze the admin costs of insurance as to what to include or not, but in general 60-66% of the premium goes to pay on claims. Medicare has better numbers but apparently much of their capital equipment or whatever is in some other budget- so their quoted low admin costs are not truly accurate. The average physician spends 14% of their revenue on insurance collection... this obviously does not account for the time spent dealing with insurance demands. Looks like 21% of healthcare spending is on physician services - could not find what percent of that was attributed to primary care but looks like 35% of physicians are PCPs per one source.Chad: I agree- lots of variation in unnecessary

tests/procedures. I see it in our town- the large clinic is a culprit and they refer to each other excessively. One poor anxious patient had her THIRD colonoscopy for her perceived diarrhea (not really diarrhea if you take a history) and had thousands upon thousands of dollars spent through the clinic on her issue of gagging about 10 minutes after eating- another anxiety problem... I unfortunately had to refer her to that clinic for her real arthritis issues and now she is on a merry go round and I've lost the ability to be her reassuring touchstone because all these other providers are NOT listening to her and telling her to do one more test, one more test as each one comes back normal. Patient and provider are to blame... and she obviously needs better control of her anxiety which counseling should help but of course, her insurance does not pay for it.carla gibsonSubject: Re: Evidence-based CareTo: Date: Wednesday, December 17, 2008, 9:53 AM

So maybe my post wasn't food for thought - perhaps fuel for fire.

Your experience in not seeing unnecessary tests and treatments doesn't line-up with

national data. The variance and waste in care in this country is dramatic and well-

documented - and primary care shares some blame. I dislike them as much as you - I

think - but they have data based upon large pools of doctors and patients - we have

anecdote. My friend was willing to place a lot of responsibility for the undervaluation of

primary care at the doorstep of insurance companies, including his own. My question was

whether primary care docs will accept some responsibility also. Always pleased when

these kinds of things get discussed with passion:)

Chad

>

> > As we spend a good bit of energy (myself certainly included)

> > highlighting the way insurance

> > companies mistreat primary care, I thought it only fair to relay this story

> > in the interest of

> > balance...

> >

> > I was talking with a friend of mine who works for a large insurance

> > company. He told me

> > that they could pay for every experimental protocol for end-stage cancer

> > request they

> > receive each year in the U.S. if they could only get primary care docs in

> > Wichita (or any other

> > city of similar size) to stop ordering non-indicated screening labs (lfts,

> > cbcs, basic lytes, etc)

> > and CXRs on asymptomatic patients. He said specifically "we love primary

> > care when it's

> > done right because it saves us a ton of money - the problem is our

> > experience is that most

> > primary care docs don't practice EBM - and for us that's a real hurdle to

> > the logic of

> > increasing what we pay them."

> >

> > Food for thought...

> >

> > Chad

> >

> >

> >

>

>

>

> --

> If you are a patient please allow up to 24 hours for a reply by email/

> please note the new email address.

> Remember that e-mail may not be entirely secure/

> MD

>

>

> ph fax

>

[Guest guest]

Jean- your typing is almost flawless... is it really you?Tim: I was reviewing costs of health care recently.. it is difficult to analyze the admin costs of insurance as to what to include or not, but in general 60-66% of the premium goes to pay on claims. Medicare has better numbers but apparently much of their capital equipment or whatever is in some other budget- so their quoted low admin costs are not truly accurate. The average physician spends 14% of their revenue on insurance collection... this obviously does not account for the time spent dealing with insurance demands. Looks like 21% of healthcare spending is on physician services - could not find what percent of that was attributed to primary care but looks like 35% of physicians are PCPs per one source.Chad: I agree- lots of variation in unnecessary

tests/procedures. I see it in our town- the large clinic is a culprit and they refer to each other excessively. One poor anxious patient had her THIRD colonoscopy for her perceived diarrhea (not really diarrhea if you take a history) and had thousands upon thousands of dollars spent through the clinic on her issue of gagging about 10 minutes after eating- another anxiety problem... I unfortunately had to refer her to that clinic for her real arthritis issues and now she is on a merry go round and I've lost the ability to be her reassuring touchstone because all these other providers are NOT listening to her and telling her to do one more test, one more test as each one comes back normal. Patient and provider are to blame... and she obviously needs better control of her anxiety which counseling should help but of course, her insurance does not pay for it.carla gibsonSubject: Re: Evidence-based CareTo: Date: Wednesday, December 17, 2008, 9:53 AM

So maybe my post wasn't food for thought - perhaps fuel for fire.

Your experience in not seeing unnecessary tests and treatments doesn't line-up with

national data. The variance and waste in care in this country is dramatic and well-

documented - and primary care shares some blame. I dislike them as much as you - I

think - but they have data based upon large pools of doctors and patients - we have

anecdote. My friend was willing to place a lot of responsibility for the undervaluation of

primary care at the doorstep of insurance companies, including his own. My question was

whether primary care docs will accept some responsibility also. Always pleased when

these kinds of things get discussed with passion:)

Chad

>

> > As we spend a good bit of energy (myself certainly included)

> > highlighting the way insurance

> > companies mistreat primary care, I thought it only fair to relay this story

> > in the interest of

> > balance...

> >

> > I was talking with a friend of mine who works for a large insurance

> > company. He told me

> > that they could pay for every experimental protocol for end-stage cancer

> > request they

> > receive each year in the U.S. if they could only get primary care docs in

> > Wichita (or any other

> > city of similar size) to stop ordering non-indicated screening labs (lfts,

> > cbcs, basic lytes, etc)

> > and CXRs on asymptomatic patients. He said specifically "we love primary

> > care when it's

> > done right because it saves us a ton of money - the problem is our

> > experience is that most

> > primary care docs don't practice EBM - and for us that's a real hurdle to

> > the logic of

> > increasing what we pay them."

> >

> > Food for thought...

> >

> > Chad

> >

> >

> >

>

>

>

> --

> If you are a patient please allow up to 24 hours for a reply by email/

> please note the new email address.

> Remember that e-mail may not be entirely secure/

> MD

>

>

> ph fax

>

[Guest guest]

The general public and people who don't really know much about medicine mix up unneccessary tests with unneccessary procedures. There's an enormous difference between an unneccessary TSH and an unneccessary colonoscopy. In terms of cost as well as risk.

I agree with that even if there are a bunch of unneccesary tests going on, which I'm not completely convinced of, they don't hold a candle to the procedures. MRIs, CTs, (even for screening for goodness sake), 3 colonoscopies!!!, arthroscopies, spinal fusions, angiograms, you name it.

Where primary care can take the blame is in referring unnecessarily to our colleagues who feel they haven't done their job until they have ordered some really expensive test or procedure. We need to listen, diagnose, treat to the best of our ability, even if that means saying "no, you don't need to see a .........ist". That takes time, and taking time requires we be paid accordingly.

Lonna

From: chadcostley <chadcostley@ mac.com>Subject: [Practiceimprovemen t1] Re: Evidence-based CareTo: Practiceimprovement 1yahoogroups (DOT) comDate: Wednesday, December 17, 2008, 9:53 AM

So maybe my post wasn't food for thought - perhaps fuel for fire. Your experience in not seeing unnecessary tests and treatments doesn't line-up with national data. The variance and waste in care in this country is dramatic and well-documented - and primary care shares some blame. I dislike them as much as you - I think - but they have data based upon large pools of doctors and patients - we have anecdote. My friend was willing to place a lot of responsibility for the undervaluation of primary care at the doorstep of insurance companies, including his own. My question was whether primary care docs will accept some responsibility also. Always pleased when these kinds of things get discussed with passion:)Chad> > > As we spend a good bit of energy (myself certainly included)> > highlighting the way insurance> > companies mistreat primary care, I thought it only fair to relay this story> > in the interest of> > balance...> >> > I was talking with a friend of mine who works for a large insurance> > company. He told me> > that they could pay for every experimental protocol for end-stage cancer> > request they> > receive each year in the U.S. if they could only get primary care docs in> > Wichita (or any other> > city of similar size) to stop ordering non-indicated screening labs (lfts,> > cbcs, basic lytes, etc)> > and CXRs on asymptomatic patients. He said specifically "we love primary> > care when it's>

> done right because it saves us a ton of money - the problem is our> > experience is that most> > primary care docs don't practice EBM - and for us that's a real hurdle to> > the logic of> > increasing what we pay them."> >> > Food for thought...> >> > Chad> >> > > >> > > > -- > If you are a patient please allow up to 24 hours for a reply by email/> please note the new email address.> Remember that e-mail may not be entirely secure/> MD> > > ph fax >

[Guest guest]

Chad,

Maybe this is a bit tangential, but when I

give lectures to other docs, I always bring up the statistics I once heard

about a study that AAA did. They asked drivers two questions: 1) “Are you

a good driver?” and 2) “What percentage of drivers on the road are

good drivers?”. Generally, around 75% answered

yes to the first question while the average for the second question was around

35%. This is telling because that means at least 35% of drivers feel like they

are a good driver even though others do not think they are.

The point is that when you are passionate

about something, you really want to believe you are doing a great job. If you

look at any study of quality in medicine, there is huge room for improvement.

Heck, even the initial IMP study showed only 60-65% of patients said they were

getting “perfect care” (meaning 35-40% did not strongly agree that

they were). So we are left with a few paths: we can admit we are providing poor

care and stick our heads in the sand and do nothing (ex. How am I going to

change? I am in a hospital-owned system and have to see 35 patients a day. I

have a non-compete clause and certainly cannot afford

to move. I am just maintaining the status quo as I am burned out), we can admit

we are providing poor care and do whatever we can to change it (ex. researching

out the IMP principles and either making the leap to your own practice or

integrating some or all of them into your current practice), or we can deny

that anything needs changing (ex. “my patients love me”, “I

am making a great living”, “I don’t need to worry about all

this quality crap—all those studies were done in other patient

populations. I bet if someone (to be read as not me)

looked at mine, I would be doing great”).

Change does not happen without momentum.

Something has to push you to change, particularly if you are emotionally invested

in what you are doing. There is plenty of blame to go around as no one is

perfect (although statistically Lynn and and are close). There

will also be plenty of anger and tears as the wheels of change begin to really

turn in the next few years. BUT, at least the wheels are beginning to turn. And

as they turn, let’s hope the IMPs are empowered

to do some of the driving. I think if that happens, your friend’s argument

will be mute.

Re: Evidence-based Care

So maybe my post wasn't food for thought - perhaps fuel for fire.

Your experience in not seeing unnecessary tests and treatments doesn't line-up

with

national data. The variance and waste in care in this country is dramatic and

well-

documented - and primary care shares some blame. I dislike them as much as you

- I

think - but they have data based upon large pools of doctors and patients - we

have

anecdote. My friend was willing to place a lot of responsibility for the

undervaluation of

primary care at the doorstep of insurance companies, including his own. My

question was

whether primary care docs will accept some responsibility also. Always pleased

when

these kinds of things get discussed with passion:)

Chad

>

> > As we spend a good bit of energy (myself certainly included)

> > highlighting the way insurance

> > companies mistreat primary care, I thought it only fair to relay this

story

> > in the interest of

> > balance...

> >

> > I was talking with a friend of mine who works for a large insurance

> > company. He told me

> > that they could pay for every experimental protocol for end-stage

cancer

> > request they

> > receive each year in the U.S. if they could only get primary care

docs in

> > Wichita (or any other

> > city of similar size) to stop ordering non-indicated screening labs

(lfts,

> > cbcs, basic lytes, etc)

> > and CXRs on asymptomatic patients. He said specifically " we love

primary

> > care when it's

> > done right because it saves us a ton of money - the problem is our

> > experience is that most

> > primary care docs don't practice EBM - and for us that's a real

hurdle to

> > the logic of

> > increasing what we pay them. "

> >

> > Food for thought...

> >

> > Chad

> >

> >

> >

>

>

>

> --

> If you are a patient please allow up to 24 hours for a reply by email/

> please note the new email address.

> Remember that e-mail may not be entirely secure/

> MD

>

>

> ph fax

>

[Guest guest]

Chad,

Maybe this is a bit tangential, but when I

give lectures to other docs, I always bring up the statistics I once heard

about a study that AAA did. They asked drivers two questions: 1) “Are you

a good driver?” and 2) “What percentage of drivers on the road are

good drivers?”. Generally, around 75% answered

yes to the first question while the average for the second question was around

35%. This is telling because that means at least 35% of drivers feel like they

are a good driver even though others do not think they are.

The point is that when you are passionate

about something, you really want to believe you are doing a great job. If you

look at any study of quality in medicine, there is huge room for improvement.

Heck, even the initial IMP study showed only 60-65% of patients said they were

getting “perfect care” (meaning 35-40% did not strongly agree that

they were). So we are left with a few paths: we can admit we are providing poor

care and stick our heads in the sand and do nothing (ex. How am I going to

change? I am in a hospital-owned system and have to see 35 patients a day. I

have a non-compete clause and certainly cannot afford

to move. I am just maintaining the status quo as I am burned out), we can admit

we are providing poor care and do whatever we can to change it (ex. researching

out the IMP principles and either making the leap to your own practice or

integrating some or all of them into your current practice), or we can deny

that anything needs changing (ex. “my patients love me”, “I

am making a great living”, “I don’t need to worry about all

this quality crap—all those studies were done in other patient

populations. I bet if someone (to be read as not me)

looked at mine, I would be doing great”).

Change does not happen without momentum.

Something has to push you to change, particularly if you are emotionally invested

in what you are doing. There is plenty of blame to go around as no one is

perfect (although statistically Lynn and and are close). There

will also be plenty of anger and tears as the wheels of change begin to really

turn in the next few years. BUT, at least the wheels are beginning to turn. And

as they turn, let’s hope the IMPs are empowered

to do some of the driving. I think if that happens, your friend’s argument

will be mute.

Re: Evidence-based Care

So maybe my post wasn't food for thought - perhaps fuel for fire.

Your experience in not seeing unnecessary tests and treatments doesn't line-up

with

national data. The variance and waste in care in this country is dramatic and

well-

documented - and primary care shares some blame. I dislike them as much as you

- I

think - but they have data based upon large pools of doctors and patients - we

have

anecdote. My friend was willing to place a lot of responsibility for the

undervaluation of

primary care at the doorstep of insurance companies, including his own. My

question was

whether primary care docs will accept some responsibility also. Always pleased

when

these kinds of things get discussed with passion:)

Chad

>

> > As we spend a good bit of energy (myself certainly included)

> > highlighting the way insurance

> > companies mistreat primary care, I thought it only fair to relay this

story

> > in the interest of

> > balance...

> >

> > I was talking with a friend of mine who works for a large insurance

> > company. He told me

> > that they could pay for every experimental protocol for end-stage

cancer

> > request they

> > receive each year in the U.S. if they could only get primary care

docs in

> > Wichita (or any other

> > city of similar size) to stop ordering non-indicated screening labs

(lfts,

> > cbcs, basic lytes, etc)

> > and CXRs on asymptomatic patients. He said specifically " we love

primary

> > care when it's

> > done right because it saves us a ton of money - the problem is our

> > experience is that most

> > primary care docs don't practice EBM - and for us that's a real

hurdle to

> > the logic of

> > increasing what we pay them. "

> >

> > Food for thought...

> >

> > Chad

> >

> >

> >

>

>

>

> --

> If you are a patient please allow up to 24 hours for a reply by email/

> please note the new email address.

> Remember that e-mail may not be entirely secure/

> MD

>

>

> ph fax

>

[Guest guest]

No Carla it is not me :)It is some crabby person in Maine beset with an icy driveway and and other winter troubles!Far be it from me to say there is not tremendous variation in careand far be it form me to say PCPs practice perfectly Duh -i would not have left former sites and changed how i work if that were true!

But BLAMING docs for ordereing unnecessary small change tests I still think is a crock of blankAs someone else rightly says well how about making this country be easily able to transform evidence into action?

how about a SYSTEM that says how to find GOOD evidence easily How about specialty societies a nd guidelines that donot disagree with each other leaving docs on the hook to make their best decisions with " educated " patietns who can also not get good info?

This is why I go crazy then some rich well rested person not in practice BLAMES PCPs Simply not the right way to expend energy Simply not a postiive . does nothing t o allevaite the halthcare mess.And simply inaccurate " we could cover all the treamtent s needed if PCP stopped ordering unnecessary screening tests " Oh please!

with some bad typing thrown in just for CArla.

Jean- your typing is almost flawless... is it really you?Tim: I was reviewing costs of health care recently.. it is difficult to analyze the admin costs of insurance as to what to include or not, but in general 60-66% of the premium goes to pay on claims. Medicare has better numbers but apparently much of their capital equipment or whatever is in some other budget- so their quoted low admin costs are not truly accurate. The average physician spends 14% of their revenue on insurance collection... this obviously does not account for the time spent dealing with insurance demands.

Looks like 21% of healthcare spending is on physician services - could not find what percent of that was attributed to primary care but looks like 35% of physicians are PCPs per one source.Chad: I agree- lots of variation in unnecessary

tests/procedures. I see it in our town- the large clinic is a culprit and they refer to each other excessively. One poor anxious patient had her THIRD colonoscopy for her perceived diarrhea (not really diarrhea if you take a history) and had thousands upon thousands of dollars spent through the clinic on her issue of gagging about 10 minutes after eating- another anxiety problem... I unfortunately had to refer her to that clinic for her real arthritis issues and now she is on a merry go round and I've lost the ability to be her reassuring touchstone because all these other providers are NOT listening to her and telling her to do one more test, one more test as each one comes back normal. Patient and provider are to blame... and she obviously needs better control of her anxiety which counseling should help but of course, her insurance does not pay for it.

carla gibson

Subject: Re: Evidence-based CareTo: Date: Wednesday, December 17, 2008, 9:53 AM

So maybe my post wasn't food for thought - perhaps fuel for fire.

Your experience in not seeing unnecessary tests and treatments doesn't line-up with

national data. The variance and waste in care in this country is dramatic and well-

documented - and primary care shares some blame. I dislike them as much as you - I

think - but they have data based upon large pools of doctors and patients - we have

anecdote. My friend was willing to place a lot of responsibility for the undervaluation of

primary care at the doorstep of insurance companies, including his own. My question was

whether primary care docs will accept some responsibility also. Always pleased when

these kinds of things get discussed with passion:)

Chad

>

> > As we spend a good bit of energy (myself certainly included)

> > highlighting the way insurance

> > companies mistreat primary care, I thought it only fair to relay this story

> > in the interest of

> > balance...

> >

> > I was talking with a friend of mine who works for a large insurance

> > company. He told me

> > that they could pay for every experimental protocol for end-stage cancer

> > request they

> > receive each year in the U.S. if they could only get primary care docs in

> > Wichita (or any other

> > city of similar size) to stop ordering non-indicated screening labs (lfts,

> > cbcs, basic lytes, etc)

> > and CXRs on asymptomatic patients. He said specifically " we love primary

> > care when it's

> > done right because it saves us a ton of money - the problem is our

> > experience is that most

> > primary care docs don't practice EBM - and for us that's a real hurdle to

> > the logic of

> > increasing what we pay them. "

> >

> > Food for thought...

> >

> > Chad

> >

> >

> >

>

>

>

> --

> If you are a patient please allow up to 24 hours for a reply by email/

> please note the new email address.

> Remember that e-mail may not be entirely secure/

> MD

>

>

> ph fax

>

-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

Wow And Brady told me he HATES change....( I am really very nice. just very crabby today)

Chad,

Maybe this is a bit tangential, but when I

give lectures to other docs, I always bring up the statistics I once heard

about a study that AAA did. They asked drivers two questions: 1) "Are you

a good driver?" and 2) "What percentage of drivers on the road are

good drivers?". Generally, around 75% answered

yes to the first question while the average for the second question was around

35%. This is telling because that means at least 35% of drivers feel like they

are a good driver even though others do not think they are.

The point is that when you are passionate

about something, you really want to believe you are doing a great job. If you

look at any study of quality in medicine, there is huge room for improvement.

Heck, even the initial IMP study showed only 60-65% of patients said they were

getting "perfect care" (meaning 35-40% did not strongly agree that

they were). So we are left with a few paths: we can admit we are providing poor

care and stick our heads in the sand and do nothing (ex. How am I going to

change? I am in a hospital-owned system and have to see 35 patients a day. I

have a non-compete clause and certainly cannot afford

to move. I am just maintaining the status quo as I am burned out), we can admit

we are providing poor care and do whatever we can to change it (ex. researching

out the IMP principles and either making the leap to your own practice or

integrating some or all of them into your current practice), or we can deny

that anything needs changing (ex. "my patients love me", "I

am making a great living", "I don't need to worry about all

this quality crap—all those studies were done in other patient

populations. I bet if someone (to be read as not me)

looked at mine, I would be doing great").

Change does not happen without momentum.

Something has to push you to change, particularly if you are emotionally invested

in what you are doing. There is plenty of blame to go around as no one is

perfect (although statistically Lynn and and are close). There

will also be plenty of anger and tears as the wheels of change begin to really

turn in the next few years. BUT, at least the wheels are beginning to turn. And

as they turn, let's hope the IMPs are empowered

to do some of the driving. I think if that happens, your friend's argument

will be mute.

Re: Evidence-based Care

So maybe my post wasn't food for thought - perhaps fuel for fire.

Your experience in not seeing unnecessary tests and treatments doesn't line-up

with

national data. The variance and waste in care in this country is dramatic and

well-

documented - and primary care shares some blame. I dislike them as much as you

- I

think - but they have data based upon large pools of doctors and patients - we

have

anecdote. My friend was willing to place a lot of responsibility for the

undervaluation of

primary care at the doorstep of insurance companies, including his own. My

question was

whether primary care docs will accept some responsibility also. Always pleased

when

these kinds of things get discussed with passion:)

Chad

>

> > As we spend a good bit of energy (myself certainly included)

> > highlighting the way insurance

> > companies mistreat primary care, I thought it only fair to relay this

story

> > in the interest of

> > balance...

> >

> > I was talking with a friend of mine who works for a large insurance

> > company. He told me

> > that they could pay for every experimental protocol for end-stage

cancer

> > request they

> > receive each year in the U.S. if they could only get primary care

docs in

> > Wichita (or any other

> > city of similar size) to stop ordering non-indicated screening labs

(lfts,

> > cbcs, basic lytes, etc)

> > and CXRs on asymptomatic patients. He said specifically " we love

primary

> > care when it's

> > done right because it saves us a ton of money - the problem is our

> > experience is that most

> > primary care docs don't practice EBM - and for us that's a real

hurdle to

> > the logic of

> > increasing what we pay them. "

> >

> > Food for thought...

> >

> > Chad

> >

> >

> >

>

>

>

> --

> If you are a patient please allow up to 24 hours for a reply by email/

> please note the new email address.

> Remember that e-mail may not be entirely secure/

> MD

>

>

> ph fax

>

-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

Wow And Brady told me he HATES change....( I am really very nice. just very crabby today)

Chad,

Maybe this is a bit tangential, but when I

give lectures to other docs, I always bring up the statistics I once heard

about a study that AAA did. They asked drivers two questions: 1) "Are you

a good driver?" and 2) "What percentage of drivers on the road are

good drivers?". Generally, around 75% answered

yes to the first question while the average for the second question was around

35%. This is telling because that means at least 35% of drivers feel like they

are a good driver even though others do not think they are.

The point is that when you are passionate

about something, you really want to believe you are doing a great job. If you

look at any study of quality in medicine, there is huge room for improvement.

Heck, even the initial IMP study showed only 60-65% of patients said they were

getting "perfect care" (meaning 35-40% did not strongly agree that

they were). So we are left with a few paths: we can admit we are providing poor

care and stick our heads in the sand and do nothing (ex. How am I going to

change? I am in a hospital-owned system and have to see 35 patients a day. I

have a non-compete clause and certainly cannot afford

to move. I am just maintaining the status quo as I am burned out), we can admit

we are providing poor care and do whatever we can to change it (ex. researching

out the IMP principles and either making the leap to your own practice or

integrating some or all of them into your current practice), or we can deny

that anything needs changing (ex. "my patients love me", "I

am making a great living", "I don't need to worry about all

this quality crap—all those studies were done in other patient

populations. I bet if someone (to be read as not me)

looked at mine, I would be doing great").

Change does not happen without momentum.

Something has to push you to change, particularly if you are emotionally invested

in what you are doing. There is plenty of blame to go around as no one is

perfect (although statistically Lynn and and are close). There

will also be plenty of anger and tears as the wheels of change begin to really

turn in the next few years. BUT, at least the wheels are beginning to turn. And

as they turn, let's hope the IMPs are empowered

to do some of the driving. I think if that happens, your friend's argument

will be mute.

Re: Evidence-based Care

So maybe my post wasn't food for thought - perhaps fuel for fire.

Your experience in not seeing unnecessary tests and treatments doesn't line-up

with

national data. The variance and waste in care in this country is dramatic and

well-

documented - and primary care shares some blame. I dislike them as much as you

- I

think - but they have data based upon large pools of doctors and patients - we

have

anecdote. My friend was willing to place a lot of responsibility for the

undervaluation of

primary care at the doorstep of insurance companies, including his own. My

question was

whether primary care docs will accept some responsibility also. Always pleased

when

these kinds of things get discussed with passion:)

Chad

>

> > As we spend a good bit of energy (myself certainly included)

> > highlighting the way insurance

> > companies mistreat primary care, I thought it only fair to relay this

story

> > in the interest of

> > balance...

> >

> > I was talking with a friend of mine who works for a large insurance

> > company. He told me

> > that they could pay for every experimental protocol for end-stage

cancer

> > request they

> > receive each year in the U.S. if they could only get primary care

docs in

> > Wichita (or any other

> > city of similar size) to stop ordering non-indicated screening labs

(lfts,

> > cbcs, basic lytes, etc)

> > and CXRs on asymptomatic patients. He said specifically " we love

primary

> > care when it's

> > done right because it saves us a ton of money - the problem is our

> > experience is that most

> > primary care docs don't practice EBM - and for us that's a real

hurdle to

> > the logic of

> > increasing what we pay them. "

> >

> > Food for thought...

> >

> > Chad

> >

> >

> >

>

>

>

> --

> If you are a patient please allow up to 24 hours for a reply by email/

> please note the new email address.

> Remember that e-mail may not be entirely secure/

> MD

>

>

> ph fax

>

-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

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